{"id":"6ffec8564847","type":"article","url":"https://hartvaat.nl/2026/10/15/lage-voorspelde-adherentie-verhoogt-stroke-risico-bij-af-patienten-die-starten-m/","title":"Lage voorspelde adherentie verhoogt stroke-risico bij AF-patiënten die starten met orale anticoagulatie","title_en":"Predicted adherence and ischaemic stroke risk in atrial fibrillation patients initiating oral anticoagulation: A cohort study of the medication adherence score.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"International journal of cardiology","doi":"10.1016/j.ijcard.2026.134660","source_url":"https://doi.org/10.1016/j.ijcard.2026.134660","authors":["Jos Perdeck","Reinoud E Knops","Joris R de Groot","Martin C Burke","Vivek Y Reddy","Tom F Brouwer"],"significance":5,"published":"2026-08-08","source_date":"2026-10-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"In a retrospective cohort study of 11,233 AF patients with a CHA₂DS₂-VASc score ≥ 2 initiating oral anticoagulation, a validated Medication Adherence Score (MAS) was used to predict adherence levels. Patients with low predicted adherence faced a significantly higher 12-month risk of ischemic stroke compared to those with high adherence (subdistribution HR 0.67; 95% CI 0.56-0.80; cumulative incidence 5.08% vs. 7.97%). These findings suggest that applying the MAS at OAC initiation could help clinicians identify high-risk patients for targeted adherence support, potentially improving stroke prevention in routine practice.","created":"2026-08-01T01:09:42Z","updated":"2026-08-10T10:36:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een retrospectieve cohortstudie van 11.233 AF-patiënten met een CHA₂DS₂-VASc-score ≥ 2 die startten met orale anticoagulatie, werd de Medication Adherence Score (MAS) gebruikt om het adherentierisico in te schatten. Patiënten met een lage voorspelde adherentie hadden een significant hoger risico op ischemische stroke binnen 12 maanden (sHR 0,67; 95% BI 0,56-0,80; cumulatieve incidentie 5,08% vs. 7,97%). Deze bevinding suggereert dat de MAS op de start van de behandeling kan helpen om patiënten met een verhoogd stroke-risico te identificeren voor gerichte ondersteuning bij medicijngebruik.","abstract_original":"BACKGROUND: Medication non-adherence is a major challenge in stroke prevention in atrial fibrillation (AF), yet no validated tool exists to identify patients at risk of non-adherence at the time of oral anticoagulation (OAC) initiation. METHODS: In this retrospective cohort study at a large tertiary centre in New York City (2015-2023), adults with AF and a CHA₂DS₂-VASc score ≥ 2 initiating OAC were included. Predicted medication adherence was quantified using the Medication Adherence Score (MAS), a validated algorithm incorporating demographic, socioeconomic, and geographic attributes, dichotomised as high (MAS ≥80) or low (MAS <80). The primary outcome was ischaemic stroke within 12 months, analysed using Fine-Gray competing-risk regression. RESULTS: Of 11,233 eligible patients, 4035 (35.9%) had high and 7198 (64.1%) had low predicted adherence. Most patients received a direct oral anticoagulant (DOAC, 70.3%), 10.7% received warfarin, and 19.0% switched agents. Ischaemic stroke occurred in 6.2% of patients. High predicted adherence was associated with significantly lower stroke risk (sHR 0.67; 95% CI 0.56-0.80), with 12-month cumulative incidences of 5.08% vs. 7.97%. Continuously modelled MAS confirmed a dose-response relationship (HR 0.98 per unit increase; 95% CI 0.97-0.99). Results were consistent after excluding patients with prior stroke (sHR 0.66; 95% CI 0.53-0.83). CONCLUSIONS: In AF patients initiating OAC, low predicted medication adherence is independently associated with increased ischaemic stroke risk. The MAS may support early identification of high-risk patients, enabling targeted adherence interventions at OAC initiation."}